[The End-of-Life Care Experienced by a Patient with Oral Cancer and Dementia Who Requested Home Palliative Care]

Abstract

The number of patients and families who wish to spend their final moments at home is increasing, and in the future, there may be more opportunities to provide end-of-life care for oral cancer at home. We report our experience with palliative treatment for a terminal oral cancer patient with dementia who wished for home palliative care. The patient was an 87-year-old male with a history of Alzheimer's dementia and chronic heart failure. In late September 2022, he visited a nearby internal medicine clinic with complaints of loss of appetite and pain in the right maxillary gingiva and was referred to a tertiary medical institution in the prefecture for further examination and treatment. At the initial visit, a 40×30 mm easily bleeding ulcerative lesion was observed in the right maxillary molar gingiva. Based on various examinations, he was diagnosed with squamous cell carcinoma of the right maxillary gingiva(cT4bN0M0, Stage ⅣB). However, due to dementia and severe cardiac dysfunction, he was not eligible for chemoradiotherapy and a plan for palliative treatment was made. The patient strongly wished for treatment at home and at a local hospital, and palliative treatment with a view to home palliative care was initiated. He was admitted to our internal medicine department in mid-November. Our department continued local treatment for the tumor and specialized oral care by a dental hygienist, but he passed away due to cardiac arrest in early January 2023. Although the patient passed away before transitioning to home care, smooth implementation of home palliative care requires cooperation not only from hospitals but also from the entire community, and the establishment of a comprehensive home medical support system is crucial.